The present invention relates to processes for determining insurance reimbursement rates for healthcare service providers.
Unique in the current U.S. healthcare economy, is the recognition that supply drives demand and the subsequent costs. In most every other industry in the U.S. demand for products and services follows the normal economic supply/demand curve. In the current U.S. healthcare model, evidence is compelling that increased supply actually correlates with increased healthcare costs in aggregate over time. If a piece of diagnostic equipment is needed for two patients per day, but the capacity is 12 patients per day, the result is highly predictable that 12 patients per day will receive the diagnostic procedure because of the artificial demand phenomenon.
Due to this phenomena, an approach is needed which provides a lever for U.S. healthcare payers to mitigate, or check uncontrolled expansion of the supply of certain services, without preventing them. The approach must preserve service opportunities in underserved communities; promote geographically appropriate services; and, address all new diagnostic procedures resulting from equipment of any cost.
Essential to arresting the growth of artificial demand, the approach must avoid interfering with the respected provider-patient relationship and the provider's medical and clinical judgment. The healthcare community culture believes that any program deemed to come between the providers and their patients is not acceptable.